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(PA school) CAM I > Neurology I Highlights > Flashcards

Neurology I Highlights Flashcards

1
Q

Coma is when a pt is unarousable and unresponsive for ___________

A

> 1 hr

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2
Q

True or false: Reflexes may still be intact with coma

A

True

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3
Q

What do you need to repeat when a pt is in a coma?

A

Neurological checks

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4
Q

What is a diagnosis of brain death based on?

A

Clinical exam

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5
Q

What LOC can still have sleep-wake cycles and make sounds?

A

Pts in a vegetative state

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6
Q

What LOC may appear awake but have no meaningful activity and no purposeful movement or meaningful speech?

A

Vegetative state

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7
Q

What LOC is characterized by inconsistent levels of consciousness and some self-awareness?

A

Minimally conscious

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8
Q
A
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9
Q

For each cause of coma, describe what the pupils would look like:
1) Toxic and metabolic disorders
2) Midbrain lesion or herniation
3) Pontine lesion
4) Opiate overdose

(not highlighted but she said it’s impt)

A

1) Normal (usually)
2) Unilateral or bilateral “blown” pupils
3) Small, responsive to light bilaterally
4) Pinpoint pupils bilaterally

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10
Q

Motor function is absent and cognition is intact in what LOC?

A

Locked-in syndrome

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11
Q

What LOC pts are mute and quadriplegic, but still conscious?

A

Locked-in syndrome

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12
Q

In what LOC is the corticospinal tract usually affected?

A

Locked-in syndrome

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13
Q

What is aphasia and what causes it?

A

Inability to express or receive written/verbal communication; damage to Wernicke’s or Broca’s areas

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14
Q

1) Define agnosia
2) What causes it?
3) Give examples

A

1) Inability to recognize things/people/places
2) Damage to parietal, temporal or occipital lobes
3) Astereognosis, topographic agnosia

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15
Q

1) Define apraxia
2) What can cause it?

A

1) Disordered skilled movements; can perform, but does so incorrectly
2) Can be widespread or focal cerebral damage

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16
Q

1) Define amnesia
2) List some potential causes

A

1) Memory loss (recent or new memories)
2) Damage to hippocampus: stressful events, ischemia, h/o migraines, advanced age, injuries, drugs, alcohol, trauma, neurologic conditions

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17
Q

Subdural hematomas affect what?

A

Bridging veins

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18
Q

How do you know if something is a subdural hematoma?

A

CT scan; will not cross midline

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19
Q

slide 22

A

Most patients present with ipsilateral pupillary dilation and contralateral hemiparesis
** check to see if patient on anticoagulants

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20
Q

When do you need to intubate a pt on the Glasgow coma scale?

A

If = or > 8

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21
Q

How do you test for subdural hematoma?

(not highlighted but emphasized in class)

A

“Halo” of CSF around bloody discharge on white cloth/coffee filter

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22
Q

Characterizing Headaches: What are some main ways to do this?

A

Primary and secondary & acute and chronic

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23
Q

How do you Tx subdural hematomas?

A

Admit to hospital and neurosurgery consult

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24
Q

What is your job as a PA when a pt presents with a headache?

A

Decide if “benign” headache vs. headache with dangerous neurologic or systemic pathology (Red Flag)

25
Q

Most headache diagnoses are based primarily on which of the following?
A. history
B. exam findings
C. laboratory testing
D. imaging

A

A. history

26
Q

Most headache diagnoses made based on what?

A

A detailed history

27
Q

1) What headaches are episodic, severe, unilateral with periorbital pain?
2) How long do these headaches last?

A

1) Cluster headaches
2) 15 min- 3 hr

28
Q

A pt being agitated and their headache being worse with activity are characteristics of what?

A

Cluster headaches

29
Q

slide 34

A

trigeminal autonomic cephalgia,

30
Q

How to rule out DDxs for cluster headaches?

A

Ipsilateral autonomic symptoms

31
Q

What is the main Tx for cluster headaches?

A

High flow O2 via non-rebreather mask

32
Q

True or false: Migraine patients will have normal neuro exam.

A

True

33
Q

Migraine headaches

A

4-72 hrs w/o tx

34
Q

What should you not mistake a migraine for?

A

A stroke

35
Q

List 4 primary characteristics of migraines

A

Unilateral
Pulsating
Nausea or vomiting
Photo or phonophobia

36
Q

What type of HA is much more common in females?

A

Migraines

37
Q

How do you differentiate migraines and strokes?

A

Normal neuro exam w. migraine

38
Q

slide 40

A
39
Q

slide 40

A
40
Q

What should you avoid in treating migraine pts?

A

NEVER Rx opioids

41
Q

True or false: Corticosteroids can be used to reduce occurrence of migraines, but do not work acutely

A

True

42
Q

True or false: migraines are throbbing, not pulsating

A

True

43
Q

44

A

(non-pulsating)
Not aggravated by routine physical activity

44
Q

What is the most common headache type?

A

Tension headaches

45
Q

45

A

NO focal neuro deficits

46
Q

Tension headaches:
1) What is most likely if it’s chronic?
2) What are some DDxs?
3) What are the potential Txs?

A

1) Chronic = typically secondary to medication overuse or depression
2) Migraines, cluster HA, medication overuse, sinus HA
3) NSAIDs, nonpharmacologic interventions (acupuncture, massage, trigger point injections, PT)
* Note, Botox does not work here*

47
Q
A
48
Q

What is the most common type of headache seen in primary care?
A. cluster
B. migraine
C. tension
D. post traumatic

A

C. tension

49
Q

List 2 important low-risk HA criteria

A

not “worst headache ever”; normal neuro exam

50
Q

What is the SNNOOPPPP mnemonic for red flag Sx in pts with headaches?

A

Systemic symptoms – fever, rash, myalgia, weight loss, HTN
Neoplasm – history of cancer,
Brain primary or mets
Neurologic deficit or dysfunction – focal exam, Sz, AMS/cognitive changes
Onset abrupt (thunderclap HA)
Older patient (> 50 y/o)
Pattern change or new type of HA
Papilledema
Painful eye
Pregnancy

51
Q

What severe headache Sxs warrant emergent evaluation?

A

1) Thunderclap HA
2) Fever with neck stiffness
3) Papilledema with focal neuro signs or impaired MS
4) Acute glaucoma

52
Q

True or false: Stable primary headaches rarely need neuroimaging

A

True

53
Q

What likely suggests an underlying cause with headaches?

A

Abnormal neuro exam

54
Q

61

A

CN VII (facial nerve) (affects forehead,)

55
Q

61

A

** NO OTHER neuro deficits**

56
Q

Symptoms that can occur due to damage to the lower cranial nerves (CN 9-12) is called what?

A

Bulbar palsy

57
Q

What should you be thinking of if a pt has Bulbar palsy?

A

ALS

58
Q
A

(PA school) CAM I (36 decks)

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